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Risk Factors for Visceral Leishmaniasis in a New Epidemic Site in Amhara Region, Ethiopia

We conducted a case-control study to evaluate risk factors for visceral leishmaniasis during an epidemic in a previously unaffected district of Ethiopia. We also collected blood and bone marrow specimens from dogs in the outbreak villages. In multivariable analyses of 171 matched case-control pairs, dog ownership, sleeping under an acacia tree during the day, and habitually sleeping outside at night were associated with significantly increased risk. Specimens from 7 (3.8%) dogs were positive by immunofluorescent antibody test (IFAT) and both enzyme-linked immunosorbent assays (ELISAs), whereas Leishmania DNA was detected in 5 (2.8%) bone marrow aspirates (from 3 seropositive and 2 seronegative dogs). Insecticide-treated nets may only protect a portion of those at risk. Further research on the vectors, the role of the dog in the transmission cycle, and the effect of candidate interventions are needed to design the best strategy for control.

Received October 22, 2008. Accepted for publication January 30, 2009.

Financial support: This assessment was made possible through the help of the Ministry of Health and Regional Health Bureau authorities, the WHO representative and the Director of Addis Zemen Health Center. We also thank all the staff of MSF-Greece for their collaboration, infrastructure, and many other kinds of help. This and other VL initiatives in the region are supported by the Agencia Española de Cooperación Internacional para el Desarrollo (AECID).

^* Address correspondence to Caryn Bern, DPD, NCZVED, 4770 Buford Highway NE (MS F-22), Centers for Disease Control and Prevention, Atlanta, GA. E-mail: cxb9{at}cdc.gov

Authors’ addresses: Seife Bashaye, Malaria and Other Vector Borne Diseases, Prevention and Control Program, Ministry of Health, Addis Ababa, Ethiopia. Nohelly Nombela and Jorge Alvar, Department for the Control of Neglected Tropical Diseases, World Health Organization, 20 Avenue Appia, CH-1211Geneva 27, Switzerland. Daniel Argaw, Abate Mulugeta, and Merce Herrero, Disease Prevention and Control Programmes, World Health Organization, PO Box 3069, Menelik Avenue, UNECA Compound, Addis Ababa, Ethiopia. Javier Nieto, Carmen Chicharro, and Carmen Cañavate, WHO Collaborating Center for Leishmaniasis, Instituto de Salud Carlos III, 28220-Majadahonda, Madrid, Spain. Pilar Aparicio, Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, c/ Sinesio Delgado s/n, 28029-Madrid, Spain. Iván Darío Vélez, Programa de Estudio y Control de Enfer-medades Tropicales, Universidad de Antioquia, Apartado Aéreo 1226, Calle 62 # 52-59 Medellín, Colombia. Caryn Bern, Division of Parasitic Diseases, National Center for Zoonotic, Vector-Borne and Enteric Diseases, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA 30341.

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